{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:50:44Z","timestamp":1781661044587,"version":"3.54.5"},"reference-count":68,"publisher":"Oxford University Press (OUP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5,1]]},"abstract":"<jats:p>Objectives: This paper provides a substantive review of international literature evaluating the impact of computerized clinical decision support systems (CCDSSs) on the care of emergency department (ED) patients.<\/jats:p><jats:p>Material and Methods: A literature search was conducted using Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase electronic resources, and gray literature. Studies were selected if they compared the use of a CCDSS with usual care in a face-to-face clinical interaction in an ED.<\/jats:p><jats:p>Results: Of the 23 studies included, approximately half demonstrated a statistically significant positive impact on aspects of clinical care with the use of CCDSSs. The remaining studies showed small improvements, mainly around documentation. However, the methodological quality of the studies was poor, with few or no controls to mitigate against confounding variables. The risk of bias was high in all but 6 studies.<\/jats:p><jats:p>Discussion: The ED environment is complex and does not lend itself to robust quantitative designs such as randomized controlled trials. The quality of the research in \u223c75% of the studies was poor, and therefore conclusions cannot be drawn from these results. However, the studies with a more robust design show evidence of the positive impact of CCDSSs on ED patient care.<\/jats:p><jats:p>Conclusion: This is the first review to consider the role of CCDSSs in emergency care and expose the research in this area. The role of CCDSSs in emergency care may provide some solutions to the current challenges in EDs, but further high-quality research is needed to better understand what technological solutions can offer clinicians and patients.<\/jats:p>","DOI":"10.1093\/jamia\/ocw151","type":"journal-article","created":{"date-parts":[[2016,9,30]],"date-time":"2016-09-30T11:05:50Z","timestamp":1475233550000},"page":"655-668","source":"Crossref","is-referenced-by-count":48,"title":["The use of computerized clinical decision support systems in emergency care: a substantive review of the literature"],"prefix":"10.1093","volume":"24","author":[{"given":"Paula","family":"Bennett","sequence":"first","affiliation":[{"name":"Greater Manchester Academic Health Science Network, Citylabs, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas R","family":"Hardiker","sequence":"additional","affiliation":[{"name":"School of Nursing, Midwifery, Social Work, and Social Sciences, University of Salford, Salford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,12,23]]},"reference":[{"issue":"5","key":"2020110612383478200_ocw151-B1","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1136\/emj.20.5.402","article-title":"Emergency department overcrowding in the United States: an emerging threat to patient safety and public health","volume":"20","author":"Trzeciak","year":"2003","journal-title":"Emerg Med J."},{"key":"2020110612383478200_ocw151-B2","article-title":"Reducing attendances and waits in emergency departments. A systematic review of present innovations","volume-title":"Report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO) 2004. 18 July 2013","author":"Cooke"},{"key":"2020110612383478200_ocw151-B3","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.d2983","article-title":"Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada","volume":"342","author":"Guttmann","year":"2011","journal-title":"Brit Med J."},{"issue":"6","key":"2020110612383478200_ocw151-B4","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1136\/emermed-2011-200532","article-title":"Emergency department crowding","volume":"29","author":"Higginson","year":"2012","journal-title":"Emerg Med J."},{"issue":"12","key":"2020110612383478200_ocw151-B5","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1111\/j.1553-2712.2011.01236.x","article-title":"The association between length of emergency department boarding and mortality","volume":"18","author":"Singer","year":"2011","journal-title":"Acad Emerg Med."},{"key":"2020110612383478200_ocw151-B6"},{"key":"2020110612383478200_ocw151-B7"},{"key":"2020110612383478200_ocw151-B8"},{"issue":"11","key":"2020110612383478200_ocw151-B9","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1136\/emj.2008.059154","article-title":"Senior house officers and foundation year doctors in emergency medicine: do they perform equally? A prospective observational study","volume":"25","author":"Armstrong","year":"2008","journal-title":"Emerg Med J."},{"key":"2020110612383478200_ocw151-B10","volume-title":"Locums Make Up a Fifth of Doctors in Emergency Units at Weekends","author":"O'Dowd"},{"key":"2020110612383478200_ocw151-B11","volume-title":"A Review of Training in Seven Emergency Departments","author":"General Medical Council. Medical Education Frontline","year":"2013"},{"key":"2020110612383478200_ocw151-B12","article-title":"How is the health and social care system performing?","volume-title":"Quarterly Monitoring Report","author":"Appleby"},{"key":"2020110612383478200_ocw151-B13","volume-title":"Securing Good Care for Older People: Taking a Long Term View","author":"Wanless","year":"2006"},{"key":"2020110612383478200_ocw151-B14","author":"Health and Social Care Information Centre","journal-title":"Accident and Emergency Attendances in England 2009-2010"},{"issue":"5","key":"2020110612383478200_ocw151-B15","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1136\/emj.2005.029793","article-title":"Effect of population ageing on emergency department speed and efficiency: a historical perspective from a district general hospital in the UK","volume":"23","author":"George","year":"2006","journal-title":"Emerg Med J."},{"issue":"7","key":"2020110612383478200_ocw151-B16","doi-asserted-by":"crossref","first-page":"18","DOI":"10.7748\/en2011.11.19.7.18.c8811","article-title":"The treatment of older patients in emergency departments","volume":"19","author":"Dawood","year":"2011","journal-title":"Emergency Nurse."},{"key":"2020110612383478200_ocw151-B17","article-title":"Stretched to the limit","volume-title":"A Survey of Emergency Medicine Consultants in the UK 2013","author":"Hassan"},{"key":"2020110612383478200_ocw151-B18"},{"key":"2020110612383478200_ocw151-B19","volume-title":"Are Accident and Emergency Attendnaces Increasing?","author":"Kings Fund"},{"issue":"4","key":"2020110612383478200_ocw151-B20","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1054\/aaen.2000.0159","article-title":"Research directions for specialist practice","volume":"8","author":"Heartfield","year":"2000","journal-title":"Accident Emerg Nursing."},{"key":"2020110612383478200_ocw151-B21","volume-title":"Framework for Quality and Safety in the Emergency Department","author":"International Federation for Emergency Medicine"},{"issue":"5","key":"2020110612383478200_ocw151-B22","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.apergo.2009.12.006","article-title":"Reflective analysis of safety research in the hospital accident and emergency departments","volume":"41","author":"Wears","year":"2010","journal-title":"Appl Ergon."},{"key":"2020110612383478200_ocw151-B23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S1386-5056(01)00183-6","article-title":"Evaluating informatics applications: clinical decision support systems literature review","volume":"64","author":"Kaplan","year":"2001","journal-title":"Int J Med Inform."},{"issue":"25","key":"2020110612383478200_ocw151-B24","doi-asserted-by":"crossref","first-page":"2526","DOI":"10.1056\/NEJMsa020847","article-title":"Improving safety with information technology","volume":"348","author":"Bates","year":"2003","journal-title":"New Engl J Med."},{"issue":"15","key":"2020110612383478200_ocw151-B25","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1001\/jama.280.15.1339","article-title":"Effects of computer-based clinical decision support systems on physician performance and patient outcomes","volume":"280","author":"Hunt","year":"1998","journal-title":"JAMA."},{"issue":"91","key":"2020110612383478200_ocw151-B26","first-page":"1","article-title":"Computerised clinical decision support systems for acute care management: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes","volume":"6","author":"Sahota","year":"2011","journal-title":"Implement Sci."},{"issue":"92","key":"2020110612383478200_ocw151-B27","first-page":"1","article-title":"Computerised clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review","volume":"6","author":"Roshanov","year":"2011","journal-title":"Implement Sci."},{"issue":"1","key":"2020110612383478200_ocw151-B28","first-page":"1","article-title":"Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review","volume":"6","author":"Roshanov","year":"2011","journal-title":"Implement Sci."},{"issue":"1","key":"2020110612383478200_ocw151-B29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1748-5908-6-87","article-title":"Computerized clinical decision support systems for primary preventive care: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes","volume":"6","author":"Souza","year":"2011","journal-title":"Implement Sci."},{"issue":"1","key":"2020110612383478200_ocw151-B30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1748-5908-6-90","article-title":"Computerized clinical decision support systems for therapeutic drug monitoring and dosing: a decision-maker-researcher partnership systematic review","volume":"6","author":"Nieuwlaat","year":"2011","journal-title":"Implement Sci."},{"issue":"89","key":"2020110612383478200_ocw151-B31","first-page":"1","article-title":"Computerised clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review","volume":"6","author":"Hemens","year":"2011","journal-title":"Implement Sci."},{"key":"2020110612383478200_ocw151-B32","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1748-5908-5-12","article-title":"Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: methods of a decision-maker-researcher partnership systematic review","volume":"5","author":"Haynes","year":"2010","journal-title":"Implement Sci."},{"issue":"6","key":"2020110612383478200_ocw151-B33","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.annemergmed.2013.01.028","article-title":"The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature","volume":"61","author":"Georgiou","year":"2013","journal-title":"Ann Emerg Med."},{"issue":"17 1","key":"2020110612383478200_ocw151-B34","doi-asserted-by":"crossref","first-page":"a2764","DOI":"10.1136\/bmj.a2764","article-title":"Evaluating service delivery interventions to enhance patient safety","volume":"337","author":"Brown","year":"2008","journal-title":"Brit Med J."},{"key":"2020110612383478200_ocw151-B35","volume-title":"Cochrane Effective Practice and Organsiation of Care Group","author":"EPOC"},{"key":"2020110612383478200_ocw151-B36","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration's tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"Brit Med J."},{"key":"2020110612383478200_ocw151-B37","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions: Cochrane","author":"Higgins","year":"2011"},{"key":"2020110612383478200_ocw151-B38","article-title":"Guide to evaluating the effectiveness of strategies for preventing work injuries: how to show whether a safety intervention really works. Cincinnati: Department of Health and Human Services. Public Health Service","volume-title":"Centers for Disease Control and Prevention National Institute for Occupational Safety and Health","author":"Robson"},{"issue":"3","key":"2020110612383478200_ocw151-B39","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.jemermed.2012.08.025","article-title":"Pilot study comparing sepsis management with and without electronic clinical practice guidelines in an academic emergency department","volume":"44","author":"Bond","year":"2013","journal-title":"J Emerg Med."},{"issue":"4","key":"2020110612383478200_ocw151-B40","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.ijmedinf.2012.11.006","article-title":"An asthma management system in a pediatric emergency department","volume":"82","author":"Dexheimer","year":"2013","journal-title":"Int J Med Inform."},{"issue":"1","key":"2020110612383478200_ocw151-B41","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/j.1742-6723.2008.01149.x","article-title":"Improving adherence to asthma clinical guidelines and discharge documentation from emergency departments: implementation of a dynamic and integrated electronic decision support system","volume":"21","author":"Kwok","year":"2009","journal-title":"Emerg Med Australasia."},{"issue":"5","key":"2020110612383478200_ocw151-B42","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.annemergmed.2010.12.008","article-title":"Prospective trial of real-time electronic surveillance to expedite early care of severe sepsis","volume":"57","author":"Nelson","year":"2011","journal-title":"Ann Emerg Med."},{"key":"2020110612383478200_ocw151-B43","first-page":"S198","article-title":"Effect of the implementation of an electronic clinical decision support tool on adherence to joint commission pneumonia core measures in an academic emergency department","volume":"19","author":"Gibbs","year":"2012","journal-title":"Acad Emerg Med."},{"issue":"1","key":"2020110612383478200_ocw151-B44","first-page":"107","article-title":"Randomized trial of a clinical decision support system: impact on the management of children with fever without apparent source","volume":"15","author":"Roukema","year":"2008","journal-title":"JAMIA."},{"issue":"19","key":"2020110612383478200_ocw151-B45","first-page":"1585","article-title":"Implementation of clinical guidelines using a computer charting system","volume":"278","author":"Schriger","year":"1997","journal-title":"Effect on the initial care of health care workers exposed to body fluids. JAMA."},{"issue":"2","key":"2020110612383478200_ocw151-B46","first-page":"186","article-title":"Implementation of clinical guidelines via a computer charting system: effect on the care of febrile children less than three years of age","volume":"7","author":"Schriger","year":"2000","journal-title":"JAMIA."},{"issue":"6","key":"2020110612383478200_ocw151-B47","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.annemergmed.2010.09.018","article-title":"Effectiveness and acceptability of a computerized decision support system using modified Wells criteria for evaluation of suspected pulmonary embolism","volume":"57","author":"Drescher","year":"2011","journal-title":"Ann Emerg Med."},{"issue":"2","key":"2020110612383478200_ocw151-B48","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1148\/radiol.11110951","article-title":"Effect of computerized clinical decision support on the use and yield of CT pulmonary angiography in the emergency department","volume":"262","author":"Raja","year":"2012","journal-title":"Radiology."},{"issue":"10","key":"2020110612383478200_ocw151-B49","doi-asserted-by":"crossref","first-page":"677","DOI":"10.7326\/0003-4819-151-10-200911170-00003","article-title":"A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial","volume":"151","author":"Roy","year":"2009","journal-title":"Ann Int Med."},{"key":"2020110612383478200_ocw151-B50","article-title":"Impact of electronic decision support tool on outcomes for emergency department patients with pneumonia","volume-title":"European Respiratory Society Annual Congress","author":"Jones","year":"2013"},{"issue":"4","key":"2020110612383478200_ocw151-B51","doi-asserted-by":"crossref","first-page":"389","DOI":"10.2146\/ajhp080143","article-title":"Implementation and evaluation of electronic clinical decision support for compliance with pneumonia and heart failure quality indicators","volume":"66","author":"Niemi","year":"2009","journal-title":"Am J Health Syst Pharm."},{"key":"2020110612383478200_ocw151-B52","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/1472-6947-8-35","article-title":"Improving antibiotic prescribing for adults with community acquired pneumonia: does a computerised decision support system achieve more than academic detailing alone? A time series analysis","volume":"8","author":"Buising","year":"2008","journal-title":"BMC Med Inform Decis Mak"},{"key":"2020110612383478200_ocw151-B53","first-page":"576","article-title":"The impact of a guideline-driven computer charting system on the emergency care of patients with acute low back pain","author":"Day","year":"1995","journal-title":"Proc Annu Symp Comput Appl Med Care."},{"issue":"4","key":"2020110612383478200_ocw151-B54","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1197\/j.aem.2005.09.015","article-title":"Embedded guideline information without patient specificity in a commercial emergency department computerized order-entry system","volume":"13","author":"Asaro","year":"2006","journal-title":"Acad Emerg Med."},{"issue":"2","key":"2020110612383478200_ocw151-B55","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.jemermed.2012.06.016","article-title":"Impact of a computerized order set on adherence to Centers for Disease Control guidelines for the treatment of victims of sexual assault","volume":"44","author":"Britton","year":"2013","journal-title":"J Emerg Med."},{"issue":"2","key":"2020110612383478200_ocw151-B56","first-page":"173","article-title":"The case for randomized controlled trials to assess the impact of clinical information systems","volume":"18","author":"Liu","year":"2011","journal-title":"JAMIA."},{"issue":"3","key":"2020110612383478200_ocw151-B57","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/TME.0b013e31822610d1","article-title":"Use of a clinical decision support tool to improve guideline adherence for the treatment of methicillin-resistant staphylococcus aureus: skin and soft tissue infections","volume":"33","author":"Carman","year":"2011","journal-title":"Adv Emerg Nursing J."},{"issue":"6","key":"2020110612383478200_ocw151-B58","first-page":"563","article-title":"Can an evidence-based guideline reduce unnecessary imaging of road trauma patients with cervical spine injury in the emergency department? Australas Radiol","volume":"50","author":"Goergen","journal-title":"2006"},{"issue":"10","key":"2020110612383478200_ocw151-B59","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1136\/emj.2008.065193","article-title":"Routine pain scoring does not improve analgesia provision for children in the emergency department","volume":"26","author":"Jadav","year":"2009","journal-title":"Emerg Med J."},{"issue":"2","key":"2020110612383478200_ocw151-B60","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s12245-010-0168-x","article-title":"Knowledge translation of the American College of Emergency Physicians' clinical policy on syncope using computerized clinical decision support","volume":"3","author":"Melnick","year":"2010","journal-title":"Int J Emerg Med."},{"key":"2020110612383478200_ocw151-B61","volume-title":"What Study Designs Should Be Included in an EPOC Review and What Should They Be Called?","author":"EPOC"},{"key":"2020110612383478200_ocw151-B62"},{"issue":"Pt 2","key":"2020110612383478200_ocw151-B63","first-page":"186","article-title":"EDECS: the Emergency Department Expert Charting System","volume":"8","author":"Schriger","year":"1995","journal-title":"Medinfo."},{"key":"2020110612383478200_ocw151-B64","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1197\/j.aem.2005.01.005","article-title":"Emergency triage: comparing a novel computer program with standard triage","volume":"12","author":"Dong","year":"2005","journal-title":"Acad Emerg Med."},{"issue":"1","key":"2020110612383478200_ocw151-B65","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ajem.2010.08.011","article-title":"Febrile neutropenia in EDs: the role of an electronic clinical practice guideline","volume":"30","author":"Lim","year":"2012","journal-title":"Am J Emerg Med."},{"issue":"1","key":"2020110612383478200_ocw151-B66","doi-asserted-by":"crossref","first-page":"e1000387","DOI":"10.1371\/journal.pmed.1000387","article-title":"The Impact of eHealth on the quality and safety of health care: a systematic overview","volume":"8","author":"Black","year":"2011","journal-title":"PLoS Med."},{"key":"2020110612383478200_ocw151-B67","article-title":"Enabling health care decisionmaking through clinical decision support and knowledge management","author":"Lobach"},{"issue":"6","key":"2020110612383478200_ocw151-B68","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1111\/j.1553-2712.2011.01070.x","article-title":"Using information technology to improve the quality and safety of emergency care","volume":"18","author":"Handel","year":"2011","journal-title":"Acad Emerg Med."}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/24\/3\/655\/34148361\/ocw151.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/24\/3\/655\/34148361\/ocw151.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T17:58:48Z","timestamp":1718819928000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/24\/3\/655\/2734458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,12,23]]},"references-count":68,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2016,12,23]]},"published-print":{"date-parts":[[2017,5,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocw151","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017,5]]},"published":{"date-parts":[[2016,12,23]]}}}